Provider Demographics
NPI:1881217487
Name:HOPKINS, KELSIE RAE (LSW)
Entity Type:Individual
Prefix:
First Name:KELSIE
Middle Name:RAE
Last Name:HOPKINS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 W SUPERIOR ST STE 101
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55806-1857
Mailing Address - Country:US
Mailing Address - Phone:218-733-0707
Mailing Address - Fax:
Practice Address - Street 1:2701 W SUPERIOR ST STE 101
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55806-1857
Practice Address - Country:US
Practice Address - Phone:218-733-0707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-19
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN28365104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker